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SatisfactionSurvey

1. Please select store location. *This question is required.

2. Was this your first time to visit ProCompounding Pharmacy?

3. How did you hear about ProCompounding?

Please enter an 'other' value for this selection.

4. How would you rate the courteousness/helpfulness of our staff?
(1 being the lowest and 5 the highest)

Space Cell	1	2	3	4	5
Rating	Rating: 1	Rating: 2	Rating: 3	Rating: 4	Rating: 5

5. Were the instructions provided for your compounded medication easy to understand?
(1 being the lowest and 5 the highest)

Space Cell	1	2	3	4	5
Rating	Rating: 1	Rating: 2	Rating: 3	Rating: 4	Rating: 5

6. Medication Efficacy

How well did the medication benefit your condition? Choose one.
(1 being the lowest and 5 the highest)

Space Cell	1	2	3	4	5
Rating	Rating: 1	Rating: 2	Rating: 3	Rating: 4	Rating: 5

Please explain your rating

7. Type of Medication

What type of medication was compounded for you? Choose one.

Please list any medications not included above

8. How would you rate your overall experience at ProCompounding?
(1 being the lowest and 5 the highest)

Space Cell	1	2	3	4	5
Rating	Rating: 1	Rating: 2	Rating: 3	Rating: 4	Rating: 5

9. How could we improve your experience?

10. If you are so inclined, please provide a brief testimonial as to how compounding has impacted you or your pet's life.

Name

Please share your testimonial

May we share your testimonial on our website or for marketing purposes?

11. If you have pictures, video or audio you would like to share of your pet or yourself related to your testimony, please upload below.

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